Chemo and Kidneys

Cancer has become an everyday word around here. While I have no personal acquaintance with cancer, too many friends and readers do. That got me to thinking. If you had chronic kidney disease and cancer, how would your already poorly functioning kidneys react to the chemotherapy?

We do need to start with some basics here. First, what is chemotherapy? According to the American Cancer Society at https://www.cancer.org/treatment/treatments-and-side-effects/treatment-types/chemotherapy/how-chemotherapy-drugs-work.html:

“More than 100 chemotherapy or chemo drugs are used to treat cancer – either alone or in combination with other drugs or treatments. These drugs are very different in their chemical composition, how they are taken, their usefulness in treating specific forms of cancer, and their side effects.

Chemotherapy works with the cell cycle

Chemotherapy drugs target cells at different phases of the process of forming new cells, called the cell cycle. Understanding how these drugs work helps doctors predict which drugs are likely to work well together. Doctors can also plan how often doses of each drug should be given based on the timing of the cell phases.

Cancer cells tend to form new cells more quickly than normal cells and this makes them a better target for chemotherapy drugs. However, chemo drugs can’t tell the difference between healthy cells and cancer cells. This means normal cells are damaged along with the cancer cells, and this causes side effects. Each time chemo is given, it means trying to find a balance between killing the cancer cells (in order to cure or control the disease) and sparing the normal cells (to lessen side effects).”

Uh-oh, “normal cells are damaged along with the cancer cells.” Let’s see if we can get a bit more specific here and find out what happens to kidney cells. The Canadian Cancer Society at http://www.cancer.ca/en/cancer-information/diagnosis-and-treatment/chemotherapy-and-other-drug-therapies/chemotherapy/side-effects-of-chemotherapy/kidney-damage-and-chemotherapy/?region=on#ixzz51dnKcgtI offers the following information:

“Some chemotherapy drugs can damage the kidneys (nephrotoxicity). The kidneys break down and remove many chemotherapy drugs from the body. When chemotherapy drugs break down, they make products that can damage cells in the kidneys, ureters and bladder. The potential for kidney damage varies with the type of chemotherapy drug used.

Causes

Chemotherapy drugs that can cause kidney damage include:
• cisplatin (Platinol AQ)
• carboplatin (Paraplatin)
• nitrosureas, such as carmustine (BiCNU, BCNU)
• mitomycin (Mutamycin)
• methotrexate – especially if high doses are used

Whether or not a chemotherapy drug will cause kidney damage depends on:
• the dose of the drug used
• if other drugs, which also have the potential to damage the kidney, are used at the same time
• if the person already has kidney disease”

Look at the last item on the list. That’s us; we already have kidney disease. Cancer.Net at https://www.cancer.net/navigating-cancer-care/older-adults/when-cancer-not-your-only-health-concern gives us just a bit more information about chemotherapy when you already have CKD. They also mention diabetes which is one of the leading causes of CKD.

“Diabetes. If you have diabetes, you need to monitor your blood glucose (blood sugar) levels closely during cancer treatment. Some chemotherapy and medications used to lower side effects (such as steroids) can raise your blood sugar levels. These levels might also go up because you are less physically active or under stress. Side effects like nausea and vomiting also affect your blood sugar.

Your doctor might also recommend:
• Taking low-sugar food supplements
• Taking different anti-nausea medications
• Using fast-acting insulin at times during cancer treatment
• Keeping a record of your blood sugar levels. You and your doctor can look at them during clinic visits. Controlling your blood sugar will help make sure you can stay on your cancer treatment schedule.

Kidney disease. Your kidneys might not work as well as you get older. So adults over 65 might have more problems with some types of chemotherapy. The drugs can be difficult for your kidneys to handle. This can raise your risk of kidney problems. How well your kidneys work might determine the type of chemotherapy you can have, or how often you have it.

If you are on dialysis, talk with your oncologist. Dialysis cleans your blood when your kidneys do not work well enough to do it. But dialysis may also clean the chemotherapy drugs out of your body before they can work.”

This does address older adults which is why I believe they mention age as a CKD risk factor. We know that’s not the only risk factor.

But there is hope. Take a look at what appeared in NDT (the respected European Nephrology, Dialysis, Transplantation Journal). It’s a bit a technical, but you can read more of the study at https://academic.oup.com/ndt/article/30/12/1979/2459906:

“One of the important drug-related problems in patients with renal impairment is inappropriate medication use and dosing errors…. Along this line, many cytotoxic drugs and their active/toxic metabolites are eliminated through the kidney depending on how much of the substance undergoes renal filtration, tubular secretion and/or tubular reabsorption. Hence, patients with both acute kidney injury (AKI) and CKD receiving chemotherapeutic agents often possess alterations in their pharmacokinetic parameters such as drug absorption, distribution, protein binding, biotransformation and renal excretion, which may result in the accumulation of potentially toxic components and over-dosage …. Therefore, clinicians must be wary to appropriately adjust doses of drugs that are excreted primarily by the kidneys. This requires dosing according to the calculated or measured creatinine clearance or eGFR formulas, which will allow the safe use of chemotherapy in patients with underlying kidney disease.”

Interesting to me is readers and friends’ reactions to chemo. Some have none, other than high energy for a day or two after their treatment. Others are nauseous and depleted of energy. It depends on your unique body chemistry and the ingredients in your chemo cocktail (for lack of a better term).

You can probably add quite a bit more – and I wish you would – since I am limited by a word count. Readers with kidney cancer, will you weigh in? And those who have both CKD and chemo, would you, too?

Brag time! After being included in Healthline’s Top Six Kidney Disease Blogs two years in a row, this year SlowItDownCKD has been awarded a place on BlogFeedSpot’s Top 75 Nephrology Blogs GLOBALLY. You know that expression the British readers use – gob smacked? That’s me!

I hope your Chanukah has been a mass of sweet, fried celebrations. See you on Christmas.

Oh, there’s still time to win a copy of the newly published SlowItDownCKD 2011 in the Chanukah Book Giveaway Contest. If you haven’t won a book this year, all you have to do is be the first person to correctly answer: What percentage of people with CKD are aware they have the disease?

Until next week,
Keep living your life!

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Time Flies When You’re Having Fun

IMG_1625Last week, Bear and I were in Las Vegas for a mini-family reunion. It was my mother’s nephew’s… let’s just say it was a combination of blood relatives and those we consider relatives without the blood connection.

What with the complimentary hotel room at the absolutely gorgeous SLS (which we understand was formerly the Sahara) and the gift of tickets to the outrageous show ‘Diva’ (male impersonators of female celebrities), an edifying tour of The Neon Boneyard, a family Las Vegas style buffet at Red Rock Casino, and a leisurely stroll down the overly-stimulating Fremont Street, we had a wonderful time.

I even got in my usual 20 minutes of gambling. I don’t really have tolerance or a liking for it, but it seemed the right thing to do since that was why the hotel gave us the two nights gratis. I won.IMG_1638

But in another way, I lost. My cousin Amy wasn’t there. She was part of this family. Her husband was there. Her uncle was there. Her mother and brothers were, but she wasn’t.  Three years ago she died of cancer.

She died within one week of my dearest, closest buddy on earth who also died of cancer. My buddy died of colorectal cancer. She’d refused any contact with the medical community for the last decade of her life and she paid the ultimate price for it.  A colonoscopy could have saved her life.

Almost five years ago, I had a colonoscopy… and now it’s time to have one again.  While this is not my favorite activity, I am willing to do so since cancer runs in my family and I’ve already had a bleeding polyp. These are not issues I usually share and, yes, it’s a bit awkward for me but if I can convince even one person who’s presently nauseated just thinking about colonoscopy to have one, it’s worth my personal discomfort.

While the term is becoming common, not everyone knows what a colonoscopy is. WebMd at http://www.webmd.com/colorectal-cancer/colonoscopy-16695 explains.

colonoscopy Colonoscopy is a test that allows your doctor to look at the inner lining of yoularge intestine (rectum and colon). He or she uses a thin, flexible tube called a colonoscope to look at the colon. A colonoscopy helps find ulcerscolon polyps, tumors, and areas of inflammation or bleeding. During a colonoscopy, tissue samples can be collected (biopsy) and abnormal growths can be taken out. Colonoscopy can also be used as a screening test to check for cancer or precancerous growths in the colon or rectum (polyps).

The colonoscope is a thin, flexible tube that ranges from 48 in. (122 cm) to 72 in. (183 cm) long. A small video camera is attached to the colonoscope so that your doctor can take pictures or video of the large intestine (colon). The colonoscope can be used to look at the whole colon and the lower part of the small intestine. A test called sigmoidoscopy shows only the rectum and the lower part of the colon.

Before this test, you will need to clean out your colon (colon prep). Colon prep takes 1 to 2 days, depending on which type of prep your doctor recommends. Some preps may be taken the evening before the test. For many people, the prep for a colonoscopy is more trying than the actual test. Plan to stay home during your prep time since you will need to use the bathroom often. The colon prep causes loose, frequent stools and diarrhea so that your colon will be empty for the test. The colon Normalprep may be uncomfortable and you may feel hungry on the clear liquid diet. If you need to drink a special solution as part of your prep, be sure to have clear fruit juices or soft drinks to drink after the prep because the solution tastes salty.

You have CKD; this is not the prep you will be using.

The National Institute of Health at https://www.nlm.nih.gov/medlineplus/colonoscopy.html suggests you have a colonoscopy for the following reasons.

  • To look for early signs of cancer in the colon and rectum. It may be part of a routine screening, which usually starts at age 50.
  • To look for causes of unexplained changes in bowel habits
  • To evaluate symptoms like abdominal pain, rectal bleeding, and weight loss

Let’s talk about prep a bit more. You cannot take the usually prescribed Fleet enemas or anything with oral sodium phosphate. Get it?  Sodium?  Phosphate?  Both bad news for CKDers.  One possible alternative is a polyethylene glycol (PEG) solution such as Miralax.  As usual, check with your nephrologist.

DucolaxDucolax is also often prescribed as prep for the procedure, but everydayhealth.com at http://www.everydayhealth.com/drugs/dulcolax-laxative makes clear it’s not automatically safe for CKD patients. (Bisacodyl is the compound name; Ducolax is the brand name.)  Take note of the first item on the list.

If you have any of these other conditions, you may need a dose adjustment or special tests to safely use bisacodyl:

  • kidney disease;
  • trouble swallowing;
  • a history of bowel obstruction, diverticulitis, ulcerative colitis, or other intestinal disorder; or
  • if you are taking a diuretic (“water pill”).

This is decidedly turning into a two part blog.  More on the curiously challenging concept of colonoscopy next week.

We’re not the only ones who took a vacation. Here’s a picture of the man behind the title of Loyal Reader, Geo De Angelo, on his vacation:

003

Meanwhile, back at the ranch (better known as my office), I wonder if you’re one of the winners in the GiveAway for What Is It and How Did I Get It? Early Stage Chronic Kidney DiseaseWhat is it. You know, the GiveAway in which I paid for ten of each eighth book bought. If you are, please announce yourself either here in the comments section, on the Facebook page – https://www.facebook.com/WhatHowearlyCKD – or on Twitter @SlowItDownCKD so we can publicly congratulate you. If you haven’t seen the GiveAway yet, you can at http://www.amazon.com/What-How-Did-Get-Chronic/dp/1457502143/ref=sr_1_1?ie=UTF8&qid=1445197041&sr=8-1&keywords=What+Is+It+and+How+Did+i+gET+IT%3F+Early+stage+chronic+kidney+disease.

If you missed it, no worries.  I’m presently working on a different sort of GiveAway with a certain Facebook Kidney Disease Support Group.  More on that next week when I have all the details. Oh, and let’s not forget about the twins (presently being indexed) …IMG_1398

Until next week,

Keep living your life!

Maybe Just a Little One

IMAG0269 (1)I love my dog, and because she’s recently had three surgeries for cancer, I’ve had some sleepless nights.  It looks like she’s going to be all right, but I’m tired.  So I thought about taking naps. Well, I really thought about napping after Nima sent me a chart of the value of different length naps and asked me if that information were true.

As Chronic Kidney Disease patients, most of us have sleep problems.  For a while, I experienced interrupted sleep.  That seems to have magically disappeared.  Not so, the sleep apnea which will be my constant companion for life…and why I wear the mandibular advancement device every night. Then there’s insomnia and let’s not forget restless leg syndrome.

I know, I’m rushing again.  I think I’ll start to slow down by explaining the difference between insomnia and interrupted sleep.

{As I wrote last week} According to Wikipedia – which is open to the general public for editing – this is the definition

Segmented sleep, also known as divided sleepbimodal sleep patternbifurcated sleep, or interrupted sleep, is a polyphasic or biphasic sleep pattern where two or more periods of sleep are punctuated by periods of wakefulness.

Insomnia, on the other hand, according to the Mayo Clinic at http://www.mayoclinic.org/diseases-conditions/insomnia/basics/definition/con-20024293 is

… a persistent disorder that can make it hard to fall asleep, hard to stay asleep or both, despite the opportunity for adequate sleep. With insomnia, you usually awaken feeling unrefreshed, which takes a toll on your ability to function during the day. Insomnia can sap not only your energy level and mood but also your health {which is already compromised by Chronic Kidney Disease}, work performance and quality of life

I’ve never discussed restless leg syndrome so we’ll need a definition of this, too.  MedicineNet at http://www.medicinenet.com/script/main/art.asp?articlekey=16440 tells us this is

An uncomfortable (creeping, crawling, tingling, pulling, twitching, tearing, aching, throbbing, prickling, or grabbing) sensation in the calves that occurs while sitting or while lying down. The result is an uncontrollable urge to relieve the uncomfortable sensation by moving the legs. Restless leg syndrome is a common cause of painful legs. The leg pain typically eases with motion of the legs and becomes more noticeable at rest, worsens during the early evening or later at night, and may cause insomnia.

Whoa, there’s a lot keeping us up at night!

Well, what about napping?  I found this wonderfully explanatory chart on the web. What I truly liked about it is all the attributions at the bottom.  I didn’t know much of this and found it too enticing not to share the entire chart with you.  The source is Positive Med at http://positivemed.com/2012/09/17/napping/napping

As to the best way to nap, HPRC {Human Performance Resource Center, a Department of Defense initiative under the Force Health and Protection Readiness Program} at http://hprc-online.org/mind-tactics/sleep-optimization-1/sleep-optimization-strategies/nap-to-be-at-your-best-mentally  has the simplest, most direct answer:

The bottom line? Your brain requires sleep to function optimally. If you do not get the recommended seven to eight hours of sleep each night, then napping will reduce your sleep debt. Nap when you can and as long as you can to get the seven to eight hours of sleep you need every 24 hours.

No fuss, no bother, just do it.  This common sense approach to napping has me reconsidering.  If my body needs it, tells me so, and makes it difficult to function without sleep, why not nap?

Something else that’s been keeping me awake is converting The Book of Blogs: Moderate Stage Chronic Kidney Disease from digital to print. I don’t mind this at all.  My brain is bursting with ideas about this and I’m eager to get to the editing.  I’m laughing at myself for ever thinking this was going to be a piece of cake.  It’s a print book, for goodness’ sake!  That means all the click throughs and web addresses need to go.  Yet, the sources of whatever I use that someone else wrote must remain clear.41DsvandphL._BO2,204,203,200_PIsitb-stThe Book of Blogs

Thank you, thank you, thank you to all the readers who have dropped me notes that they’re already enjoying the digital copy of the book.  I hope you were all able to make use of the two day discount price of $ .99 to celebrate the publication of my second Chronic Kidney Disease Book.

While Amazon is terrific at coming up with ways to keep the book affordable, I won’t be able to do another low price or free day until April according to the contract I signed. Keep in mind that you can lend it for free for 14 days if you are a member of Kindle Unlimited.

Once I finish editing The Book of Blogs: Moderate Stage Chronic Kidney Disease for print – Book Coverand you know I’ll be sure to let you know when the print version is available – be on the lookout for a box set of this second book and my first about our disease What Is It and How Did I Get It? Early Stage Chronic Kidney Disease.

And this is where I start asking you for reviews.  I realize it’s early days {to borrow a phrase from Downton Abby} yet, but I would appreciate a review on Amazon when you finish the book. Amazon.com will be my only distributor for this book.

Until next week,

Keep living your life!

 

 

Just What The Devil Does Precancerous Mean?

I had this week’s topic all picked out, half my research done, and was chomping at the bit to start writing when the phone rang. I’d already been interrupted several times by Bear who just had foot surgery and couldn’t get around much.  I’d expected those interruptions, and was more than glad to help my sweet Bear with whatever he needed.Bear's foot

But the phone?  What made me pick it up?  I know how to let calls go right to voice mail if I need the time to finish whatever I’m working on.

It was the office of my dermatologist, Dr. Crystal Layton of Affiliated Dermatology here in Phoenix, a soothing, easy to talk to doctor. They had the results of the two shave biopsies on suspicious lesions I’d recently had during my annual full body scan.  (The second definition of lesion at The Free Online Dictionary at http://www.thefreedictionary.com/lesion is “A localized pathological change in a bodily organ or tissue.”)

The Mayo Clinic at http://www.mayoclinic.com/health/biopsy/CA00083/NSECTIONGROUP=2 explains a shave biopsy, the kind I’d had:  “During a shave biopsy, the doctor uses a tool similar to a razor to scrape the surface of your skin.”

shaveDr. Layton wanted me to know the as yet still unhealed biopsy site on my right forearm was benign.  Yay!  But wait.  The one on my forehead, the one I’d laughingly referred to as the hole in my head, was precancerous.

Just in case you need to know what happens to the biopsy material once it’s been collected, according to http://www.webmd.com/cancer/what-is-a-biopsy?page=2

“After the tissue is collected and preserved, it’s delivered to a pathologist. Pathologists are doctors who specialize in diagnosing conditions based on tissue samples and other tests. (In some cases, the doctor collecting the sample can diagnose the condition.)

pathologistA pathologist examines the biopsy tissue under a microscope. By noting the tissue cells’ type, shape, and internal activity, in most cases a pathologist can diagnose the problem.”

I knew that and I knew what a shave biopsy was and I knew what a lesion was and I still felt my stomach drop.  I also knew ‘pre’ didn’t mean cancerous, but there was cancer in the word.  We probably all know that ‘pre’ means before (from the Latin for prior).  Did that mean cancer was my inevitable future? Or my probable future if I didn’t do something about it?

Split second decision on my part.  “So, what do we do about that?” I asked, although I think I already knew the answer. The procedure is called cryosurgery (I can’t resist: cryo comes from the Greek for cold or frost.  Perfect!) which Dr. Layton’s medical group defines as “the treatment of lesions with the application of a cold substance.  In most case, liquid nitrogen is used to destroy the lesion.”cryosurgery

I made my appointment, ran to tell Bear of yet another one of those medical problems that seem to be ganging up on us lately, and came right back to my office to blog… and research.

How did this happen?  I’d had biopsies before but they were based on suspicious looking moles and were always benign.  I needed a source I trusted, so I went to Johns Hopkins Medical Library at: http://www.hopkinsmedicine.org/healthlibrary/conditions/skin_cancer/actinic_keratosis_a_precancerous_condition_85,P01335/ so, it was actinic keratosis we were dealing with this time.

What was that?  This is their definition:

“Actinic keratosis can be the first step in the development of squamous cell skin cancer, and, therefore, is considered a precancerous skin condition. The presence of actinic keratoses indicates that sun damage has occurred and that skin cancer can develop.”

I’m an optimist.  Notice the CAN in the definition?  That’s what I’m banking on.  That and the hope that my dermatologist can burn it all out so that it doesn’t get the chance to develop.

As for squamous cell, I needed help with that, too. I found it at http://www.skincancer.org/skin-cancer-information/squamous-cell-carcinoma.

“Squamous cell carcinoma (SCC) is an uncontrolled growth of abnormal cells arising in the squamous cells, which compose most of the skin’s upper layers (the epidermis). SCCs often look like scaly red patches, open sores, elevated growths with a central depression, or warts; they may crust or bleed. SCC is mainly caused by cumulative UV exposure over the course of a lifetime. It can become disfiguring and sometimes deadly if allowed to grow. An estimated 700,000 cases of SCC are diagnosed each year in the US, resulting in approximately 2,500 deaths.”Squamous-Cell-Carcinoma-in-Situ

The only risk factors I’d had were that I’d been fair skinned (I did notice my skin tone had darkened in the past decade since my move to Arizona) and I didn’t wear a hat.  I hadn’t thought I needed one since my curly dark hair always tumbled over my forehead thereby – or so I thought – protecting it from the sun’s rays.

I figured I’d better check this out to see if cryosurgery could have any effect on my kidneys.  I doubted it, but then I hadn’t known how dangerous the fluoride in toothpaste was either. I used the search term ‘liquid nitrogen’ since that’s what will be used for the cryosurgery I’ll be having.

While I may have scarring, there seem to be no indications that this substance enters the skin or blood stream much less that it exits the body via the kidneys.  Can’t exit if it never enters, right?

As for the scars, who cares?  I already have a scar on my forehead from a previous shave biopsy in this exact spot about eight years ago. That one came back benign.  Things change; be vigilant!

1395242_10202162033990289_511259525_nSince we’ve been absorbed with Bear’s surgery for the last week, there’s nothing to report on either book sales or SlowItDown.  The big news is that Nima, my daughter and computer guru, is in the process of adding a media and press page to this blog.  Thank you, Nima, for doing your best to keep me current.  I know I don’t make it easy.

Until next week,

Keep living your life!

This One’s For Cheryl… And Amy… And…

It’s true, the world is a sadder place these days.  Two dynamic women have lost their lives to cancer this week, and both of them touched me.  One fought valiantly until there was nothing more to fight with. One didn’t. The end result is they’re both gone.  The cause of their deaths? Cancer.

I simply accepted that Cheryl Cook Vincent and I would grow to be outrageous old ladies together.  Now my partner in crime is no more and I am so sad. I cannot think of a single purpose her death served.

Or maybe I can. Let’s take a little detour from the usual ckd related material and talk about cancer.  It’s my way of honoring both Cheryl and my cousin, Amy Bernard-Herman.

Cancer is defined by the World English Dictionary as, “any type of malignant growth or tumour, caused by abnormal and uncontrolled cell division: it may spread through the lymphatic system or blood stream to other parts of the body.”

One of these women went to her doctors regularly; the other hadn’t been in decades. Had she gone, she would have been told pretty much the same as the one who did.  Cancer is treatable in the early stages, sometimes even curable as with skin cancer, the most common form of cancer.  Sometimes, it is not as with some breast cancer which is the second leading cause of cancer deaths in women. For men, the second leading cause of cancer is prostate cancer.

It seems that cancer really covers over one hundred different diseases rather than just being a disease all by itself according to medterms (http://www.medterms.com/script/main/art.asp?articlekey=2580). Even though it may appear in different parts of the body once it’s metastasized (spread), it’s referred to by the site where the tumors first appeared.  For example, back in 1988, my father died of pancreatic cancer.  The cancer had metastasized throughout his body by the time he died, but it was still referred to as pancreatic cancer.

Being an English teacher and a writer, I wanted to know why it’s called cancer. I found the most informative answer to my question at: http://wiki.answers.com/Q/Why_is_the_disease_cancer_called_cancer. Basically, the tumors themselves have a crab like appearance.  In the zodiac, the crab is called cancer. I enjoyed the etymology more than I should have, but that’s my ‘thing’ so I won’t bore you with it here.

Colon cancer caused Cheryl’s death, directly or not. How could she have known she had this disease? According to the Mayo Clinic, these are the symptoms (although the disease may be asymptomatic in the early stages in which case a colonoscopy would have detected it):

  • A change in your bowel habits, including diarrhea or constipation or a change in the consistency of your stool
  • Unexplained weight loss
  • Rectal bleeding or blood in your stool
  • Persistent abdominal discomfort, such as cramps, gas or pain
  • A feeling that your bowel doesn’t empty completely
  • Weakness or fatigue

Their address for more colon cancer information is: http://www.mayoclinic.com/health/colon-cancer/DS00035.

You may need a reminder as to just what these parts of the body are.  According to WebMD, who also provided the picture, the colon is the last part of the digestive system.  This is where fluid, salt, and some nutrients are removed from your body’s wastes as the digestive process occurs.  Peristalsis, or the movement of the muscles lining the colon, helps with this.  You can read more about this at: http://www.webmd.com/colorectal-cancer/default.htm.  The rectum is the last four inches of the colon, ending with the anus.

Cancer has stages just as CKD does. MedicineNet has a better explanation of just what this is and why it’s done than I could have come up with: “The stage of a cancer is a measure of the extent to which a cancer has spread in the body. Staging involves evaluation of a cancer’s size and its penetration into surrounding tissue as well as the presence or absence of metastases in the lymph nodes or other organs. Staging is important for determining how a particular cancer should be treated… cancer therapies are geared toward specific stages. Staging of a cancer also is critical in estimating the prognosis of a given patient, with higher-stage cancers generally having a worse prognosis than lower-stage cancers.”  They are on the internet at: www.MedicineNet.com.  You’d have to know which type of cancer you are dealing with since there is no general cancer site at this address.

Cheryl told me she could never do what I did.  She was talking about researching my diagnosis, writing a book about it, and urging all others with chronic kidney disease to pay attention to their condition.

After having to research each sentence of this blog, I see what she meant. It was heart wrenching.

And I never got to tell my most excellent buddy that I was able to raise my eGFR from 50 to 60 in just three months. She would get so excited about good medical news for me whether she understood it or not.

Rest in peace Cheryl… and Amy… and every other person who has died of cancer.

To those of you who remain behind, I offer you every bit of good energy I can find. After all, if we’re not here to help each other, why are we here?

No book news today, folks.

Until next week,

Keep living your life – for yourself and those around you.

Published in: on October 15, 2012 at 11:13 am  Comments (5)  
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EPO Good, No, EPO Bad

In preparing for tonight’s TwitterChat, Mandy from Libre asked me about any medications I’d like to mention.  I immediately thought of EPO. I remember when I was first diagnosed and complained of fatigue, my nephrologist at the time talked about receiving EPO intravenously.  I think he said twice a month.  And I was horrified.  I didn’t know why; I just was.  It wasn’t the needle because I was used to that already from all the blood tests CKD patients take and the IVs I’d had for various procedures.  It just felt wrong, wrong way down in my gut.  Being a great believer in things happening for a reason whether we know the reason or not, I refused.  And then I refused again.  After reading the two articles from which I’ve taken excerpts for today’s blog, I’m glad I did.

Blood protein EPO involved in origin and spread of cancer

[PRESS RELEASE 5 December 2011] Researchers at Karolinska Institutet have demonstrated that a growth hormone, PDGF-BB, and the blood protein EPO are involved in the development of cancer tumours and that they combine to help the tumours proliferate in the body. These new preclinical findings offer new potential for inhibiting tumour growth and bypassing problems of resistance that exist with many drugs in current use. The results are published in the scientific journal Nature Medicine.
       

Yihai Cao Photo: John Sennet

Angiogenesis is the formation of new blood vessels from pre-existing ones, and is one of the most important research fields in the treatment of such diverse conditions as cancer, metastases, obesity, heart disease, stroke, diabetes and chronic inflammation. The process is also important in healthy individuals for wound healing, the menstrual cycle and other normal processes. Professor Yihai Cao and his team are researching into angiogenesis and its links to cancer and other diseases, and in the present study show the significant role played by a growth factor, PDGF-BB.

“EPO has several functions,” says Professor Yihai Cao. “It produces more blood and stimulates angiogenesis, and we have revealed the underlying mechanism. It also stimulates tumour angiogenesis by directly stimulating the proliferation, migration and growth of endothelial cells and their ability to form the so-called epithelial tube. PDGF-BB promotes the stimulation of extramedullary haematopoiesis, enlargement of the liver and spleen, which increases oxygen perfusion and protection against anaemia.”

The introduction of PDGF-BB in mice thus boosts erythropoietin production and the haematopoietic parameters. In addition, EPO may directly act on tumor cells to promote their growth and metastasis.

You can find the entire article at:  http://ki.se/ki/jsp/polopoly.jsp?l=en&d=130&a=133831&newsdep=130&utm_source=twitterfeed&utm_medium=twitter . It is from Nature Medicine AOP 4 December 2011

Then I found a blog written by a doctor as a patient. This is part of that Wednesday, December 07, 2011 blog. You can read the entire blog entry at:  http://www.typepad.com/services/trackback/6a0133f61818b7970b0162fd805711970d

EPO: Lighting the Fires of Cancer

By Peter Laird, MD

Erythropoietin (EPO) is a natural hormone that mediates the production of red blood cells (RBC’s) that is primarily produced in the renal cortex and small amounts in the liver. Studies over the last decade evaluated the effects of  EPO in diverse populations at risk of anemia outside of the renal dialysis patients, especially in patients undergoing chemotherapy for a variety of cancers. Unfortunately, these studies revealed adverse survival with more rapidly progressive cancers and shortened survival. In addition, in the CKD population, patients were more likely to experience cardiovascular events and death bringing the CHOIR study to an early close as well.  The TREAT trial followed shortly with a higher risk of stroke for patients treated with EPO for CKD related anemia.

Many patients sustained with EPO for years on dialysis vocally protested the new FDA labelling changes and the removal of minimum Hb levels in the QIP. Despite the increased risk of cardiovascular outcomes with EPO and the suspected increased cancer risk for chemotherapy trials, the correction of anemia for many patients overcame the potential risks. However, a new study highlighed by Gary Peterson of RenalWEB sheds light on the role of EPO not only in promoting cancer, but it is actually involved in the development of cancers as well:

PDGF-BB modulates hematopoiesis and tumor angiogenesis by inducing erythropoietin production in stromal cells

As a cancer survivor in addition to my IgA nephropathy and dialysis, I have been very leery of EPO right from the time I first started on dialysis in 2007. My first confrontation with my health care team at dialysis came about when I refused to continue EPO shortly after beginning dialysis. In retrospect of current guidelines, I never needed EPO with a Hb over 12.0 with only iron infusions alone. The issue of adverse cardiovascular outcomes and now this new basic science information that EPO is involved in cancer formation leaves dialysis patients with hard choices. EPO prevents the need for blood transfusions and their associated complications, but at what price?

This brings up the subject of advocating for yourself.  You do NOT need to accept what a doctor tells you or recommends to you just because you are not a doctor and s/he is.  Refuse (unless it’s an emergency) and go home and research…or get a second opinion…or call another patient you trust to suggest another way of finding out if you do need this whatever it is you’re not comfortable with.

On the book front, you already know about tonight’s TwitterChat at 8-9 EST at WhatHowEarlyCKD, courtesy of Libre Clothing.  You do know about that, don’t you?  Come join us.  Bring your questions, comments and friends.  Let’s make this a lively hour.

Those of you living in Arizona, I’ll be looking forward to meeting you on Saturday, January 14th, from 1-3 at Bookman’s in Mesa.  The address is 1056 S. Country Rd.  C’mon down!

Until next week,

Keep living your life!

This is what early stage CKD looks like